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Athletic Fitness form
Please fill the form below
1
Step 1
2
Step 2
*
Athlete Name:
*
First Name
*
Last Name
This field is required.Please enter value
This field is required.Please enter value
Parent Name:
First Name
Last Name
This field is required.Please enter value
This field is required.Please enter value
Gender:
Male
Female
This field is required.Please enter value
Date of birth :
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Age:
This field is required.Please enter value
The value allows only numbers
Invalid number!
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Weight :
Invalid number !.
This field is required.Please enter value
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Height :
Invalid number !.
This field is required.Please enter value
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
*
1. Have athlete had a medical illness or injury since last check up or sports physical :
Yes
No
This field is required.Please enter value
*
2. Have athlete been hospitalized overnight in the past year :
Yes
No
This field is required.Please enter value
*
3. Does the athlete have asthma (wheezing), hay fever, or coughing spells after exercise:
Yes
No
This field is required.Please enter value
*
4. Has the athlete ever had a broken bone, had to wear a cast, or had an injury to any joint:
Yes
No
This field is required.Please enter value
*
5. Are you, the athlete, worried about any problem or condition at this time:
Yes
No
Don't Know
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Next
*
6. Is the athlete allergic to any medications or bee stings:
Yes
No
This field is required.Please enter value
*
7. Has the athlete ever suffered a heat-related illness (heat stroke):
Yes
No
This field is required.Please enter value
*
8. Does the athlete have only one of any paired organs(Eyes, ears, kidneys, testicles, ovaries):
Yes
No
This field is required.Please enter value
Please indicate medical alerts such as allergic reactions, contact lenses etc..(If have) :
This field is required.Please enter value
Declaration
An individual answering in the affirmative to any question relating to a possible
An individual answering in the affirmative to any question relating to a possible
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Date:
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
*
Upload parent signature :
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